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Is 3g rectal mesalazine enough to treat a flare-up, folks?

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Posted 12/4/2015 11:35 AM (GMT 0)
I'm new to the world of rectal meds and not looking forward to this grim initiation. I've been prescribed 2g Salofalk liquid enema and 1g Salofalk suppository 1x a day. One is to be taken in the evening, the other in the morning.

I know the max dose of oral mesalazine is 4g a day. However, I have no idea about rectal mesalazine. Incidentally, I won't touch the oral stuff until I know I can tolerate rectal mesalazine. So no oral mesalazine for now.
Posted 12/4/2015 12:41 PM (GMT 0)
I've heard the maximum for mesalamine rectal is 4 grams a day and the rowasa enemas I'd get here in the states were 4g each. Your 3 gram approach is a good start, especially if you're not sure if you're mesalamine-intolerant. The rectals also include sulfates, another potential allergen. If you have an allergic reaction then it'll be a dramatic worsening of symptoms (frequency can get exponentially worse).

I hope the mesalamine does the trick for you. Only one way to find out, try. I believe Salofalk and pentasa enemas are available in higher doses, if you get some response but need something stronger. Good luck!
Posted 12/4/2015 3:44 PM (GMT 0)

iPoop said...
The rectals also include sulfates, another potential allergen

Crap, seriously?

I had a reaction to sulfasalazine which made my reaction to mesalazine look good by comparison.

I'm honestly not sure I can bring myself to do these rectal meds at all now.
Posted 12/4/2015 4:15 PM (GMT 0)
At least the rowasa enemas here in the states do, there's a sulfate-free version here (sfRowasa for those with allergies). I don't believe the suppository have sulfates. Check with your pharmacist for clarity on what's in them before taking them, especially if you've had a known allergic reaction to sulfasalazine in the past, just to be sure.
Posted 12/4/2015 4:18 PM (GMT 0)
I don't think Rowasa is available in the UK. It's all Salofalk as far as I know. I'm gonna go and pick up the prescription now, 'cos it's already late afternoon. I'll ask the pharmacist if they contain sulfates, although if he says yes, I'm not sure what I'm gonna do exactly.
Posted 12/4/2015 4:49 PM (GMT 0)
NCOT,

I know that you've tried almost all the meds before your surgery but now that you've been reversed have you thought about trying another Biological like Entyvio?

I'm not sure what is approved in the UK but I think Simponi was recently granted approval and there might be some others in the pipeline like Cimzia or Stelara.

My GI says that sometimes when 6-mp doesn't work that for some patients Imuran will work.
Posted 12/4/2015 5:06 PM (GMT 0)
Max is 4gm rectal enema daily, but if under severe symptoms (determined by your GI) 2x4gm can be used daily for no longer than a couple of weeks or shorter as a quick attack to get control on a flare depends on the progress.

4gm enema + a Budesonide enema can be used also daily for flares.
Posted 12/4/2015 7:40 PM (GMT 0)
metabisulphate is the preservative. Probably a small amount. All you can do is try and see how you feel.

q
Posted 12/4/2015 7:53 PM (GMT 0)
The pharmacist didn't know whether there was sulfate in the rectal meds. Plus he had to order them, so I'm going to have to wait until Monday to collect them now. I just find it a bit weird that the pharmacy is serving a massive GP surgery close to the centre of town, yet it doesn't have any mesalazine enemas or suppositories in stock - obviously can't be many UC patients in my town.

ks1905 - I have indeed, but I can't jump straight from taking nothing to Entyvio. I'll probably have to go through the meds in order, from the mildest to the strongest. The only thing I can do is hasten the time I spend on each med, if they clearly are not working: my first hospital pissed me about with various mesalazine tablets for literally years before they tried azathioprine. That absolutely won't happen again - I'll give mesalazine one go and that's it.

Dreadsteel - Thanks, that's quite helpful to know.

I'm a little bit worried I've only been prescribed 14 days' worth of rectal meds. Am I right in thinking that 14 days is nothing like long enough to bring a flare-up under control?

Edit: Thanks quincy.
Posted 12/4/2015 8:07 PM (GMT 0)
It's stated that metabisulphate is preservative. Many pharmacists know squat.
What brand are you prescribed?

"Pentasa enema inactive ingredients:
disodium edetate
sodium acetate
hydrochloric acid
sodium metabisulphite
purified water"

"Salofalk enemas,
Nonmedicinal ingredients: carbomer, edetate disodium, potassium acetate, potassium metabisulfite, purified water, sodium benzoate, and xanthan gum"


14 days is usually a prescription dosage....but with refills. Hope the doc gave that to you?
q
Posted 12/4/2015 8:16 PM (GMT 0)
In the letter my IBD nurse sent to the GP it said Salofalk, but on the prescription itself it just said mesalazine enemas/suppositories. So I'm not sure if I'll get Salofalk or some non-branded generic version. I probably should have asked that while I was there, but a bit late now.

I don't think I have refills. My GP surgery is absolutely useless so if I want a refill I should start chasing one up almost straight away - like as soon as I get my meds on Monday.
Posted 12/4/2015 11:24 PM (GMT 0)
14 days worth may help a lot or just start helping. Hard to tell. Ridiculous that you weren't given refills.

I hope you tolerate the enemas. The only other option before moving up the med chain would be steriod enemas or supps.
Posted 12/5/2015 3:25 AM (GMT 0)
ncot...yeah, a good idea regarding refills, because 14 days might not cut it. It's probably Salofalk.

So, how much of your rectum was left for the ileum connection?

q
Posted 12/5/2015 5:27 AM (GMT 0)
Sulfa drug intolerance doesn't always equate to complete intolerance to sulfites, and controlling the flare is way more important than whatever smelly side effects may (will) occur.
Posted 12/5/2015 8:20 AM (GMT 0)
sherbear46 - thanks!

quincy - all my rectum and about half my sigmoid, so technically it was an ileosigmoid anastomosis. Think the surgeon said there was a foot left all in all.

IrRed - smelly side effects? Thanks for giving me something else to look forward to ;p
Posted 12/5/2015 8:36 AM (GMT 0)
i think so but I admit, in a bad flare i would throw everything i had at it. Meaning, I would do a 4g enema with a bentyl in advance and a foam steroid enema before, followed by a suppository. I still didn't have any luck. I guess that explains why I had surgery...
Posted 12/5/2015 10:03 AM (GMT 0)
My pharmacy always has to order my rectal meds...never in stock but usually available the next day.
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